NADD Bulletin Volume IV Number 5 Article 1

Complete listing

Development of an Assessment Instrument for Anxiety, Depression and Mood among Individuals with Mental Retardation

Anna J. Esbensen, J. Rojahn, Michael G. Aman, Stephen Ruedrich


No adequate screening instrument exists for anxiety and depression among individuals with mental retardation. The current research project developed the 27-item Anxiety Depression and Mood Screen (ADAMS) to fill this gap. Exploratory factor analysis with 291 individuals resulted in a 5-factor solution with factors of “Manic/Hyperactive Behaviors,” “Depressed Mood,” “Social Avoidance,” “General Anxiety,” and “Obsessive/Compulsive Behaviors.” Confirmatory factor analysis with 300 additional individuals validated this initial solution. Additional psychometric properties of the scale were good.


In the general literature, anxiety and depression share common symptoms and are frequently comorbid. These issues have not been adequately addressed with individuals with mental retardation. Few acceptable instruments exist for differentiating these disorders with this population. Currently available scales are either out of date, limited by age or level of mental retardation, or lack psychometric development. The current study attempted to create a rating scale to differentiate symptoms of anxiety and depression in this population. In addition, we sought to assess the psychometrics properties of the scale. The scale was intended for use across all levels of cognitive functioning and age groups.

Method - ADAMS

A preliminary set of 131 items was generated from DSM-IV criteria, previous assessment instruments, and in collaboration with psychologists and psychiatrists at the Nisonger Center UAP at The Ohio State University. This list was revised to render 55 items tapping anxiety, appetite, communication, compulsiveness, concentration, depression, energy level, fear, mood, physical state, sleep disturbance and social interactions. Items with low item variance and poor test-retest reliability were to be excluded from factor analyses. Items were rated on a scale of 0, “not a problem,” to 3, “severe problem.”

Method - Recruitment

•92 agencies in Ohio were contacted

•36 agreed to participate

•971 scales were distributed

•641 were returned (66% return)

•50 excluded based on criteria:

•28 respondents knew participant

less than 6 months

•19 returned scales had greater than

20% missing data

•3 participants outliers on age

•Valid sample of 591 scales:

•291 for exploratory factor analysis

•300 for confirmatory factor analysis

Method - Respondents

Sample 1Sample 2









Mean length of relationship

6.5 years6 years


residential area36.8%35.6%

sheltered workshop44.4%41.9%

treatment setting2.4%2.7%


Method – Participants

Sample 1Sample 2

Mean Age33 years39 years

Gender (male)51.9%53.2%


 family home20.7%23.7%

 group home32.3%27.4%




Level of mental retardation:







Exploratory Factor Analysis

Using the remaining 49 items, the 5 factor solution was preferred based on model fit and clinical interpretability (RMSEA < .08).

Retained factor loadings q .4

Factors labeled:

•Manic/Hyperactive Behavior

•Depressed Mood

•Social Avoidance

•General Anxiety

•Obsessive/Compulsive Behaviors

Confirmatory Factor Analysis

Model fit mediocre:

  RMSEA = .089, CI: .083-.095

NNFI = .75

Factor loadings were all q .3

Item-total correlations q .4

Results – Psychometrics

Mean Item-Total AlphaRe-TestInter-raterLoading1Correlation


Depressed Mood.

Social Avoidance.

General Anxiety.

Obsessive/Compul-sive .

Full Scale---.80.48

1.Confirmatory Factor Loading


In summary, the ADAMS was shown to be a psychometrically sound behavior-based informant report screening instrument of anxiety, mood and depression among individuals with mental retardation that is not restricted by characteristics of the individual, such as age or level of mental retardation. Pending additional psychometric assessment, the ADAMS may be useful for screening these comorbid disorders, differentiating forms of anxiety, and as an aid in the multi-method assessment of psychopathology among individuals with mental retardation.

For further information:

Anna J. Esbensen
1339 Hunter Avenue
Columbus, Ohio 43201-2772

(This material was included in a poster presentation at the 125th annual AAMR meeting in Denver, Colorado, in 2001.